Mayo Clinic, Department of Urology, 200 1st St SW, Rochester, MN, 55905, USA.
Mayo Clinic, Department of Anesthesiology, 200 1st St SW, Rochester, MN, 55905, USA.
J Pediatr Urol. 2024 Dec;20(6):1200-1204. doi: 10.1016/j.jpurol.2024.08.014. Epub 2024 Aug 29.
INTRODUCTION/BACKGROUND: The repeated or lengthy use of general anesthesia (GA) in children under three years old is cautioned against due to potential neurodevelopment effects. Spinal anesthesia (SA) has emerged as a safe and effective alternative for routine pediatric urologic procedures. In this study, we describe the use of SA in the urgent surgical treatment of neonatal testicular torsion.
We aim to evaluate the safety and efficacy of SA for urgent scrotal exploration in neonates.
We retrospectively collected data on neonates younger than 30 days old undergoing SA for the indication of testicular torsion from May 2018 to June 2022. We recorded patient demographics, adjuvant medications use, and time points for start/stop of spinal injection, procedure, and operating room utilization.
Six neonates, with an average age of 1.9 days of life and average weight of 3.4 kg, underwent scrotal exploration for testicular torsion using SA. Four patients (67%) required orchiectomy of the nonviable torsed testicle, and all patients underwent orchiopexy of the unaffected testicle. Mean total operative time was 45.3 (SD 11.7) minutes, including Gomco circumcision in five patients. One patient received preoperative intranasal dexmedetomidine for sedation. Mean time for SA administration was 6.3 (SD 5.5) minutes, with a mean total time in the operating room of 77.3 (SD 9.8) minutes. There were no perioperative or postoperative complications.
We describe a single institution experience of surgical management of neonatal torsion under SA. In this case series, SA was safely utilized for all neonates involved without the need for conversion to GA or intravenous (IV) sedation.
The use of SA is safe and efficacious for urgent scrotal exploration for testicular torsion in neonates, even those under 48 h of age. More widespread utilization requires collaboration between pediatric urologists and experienced pediatric anesthesiologists trained in SA.
简介/背景：由于潜在的神经发育影响，三岁以下儿童反复或长时间使用全身麻醉（GA）被谨慎对待。脊髓麻醉（SA）已成为小儿泌尿科常规手术的一种安全有效的替代方法。在这项研究中，我们描述了 SA 在新生儿睾丸扭转紧急手术治疗中的应用。
我们旨在评估 SA 在新生儿紧急阴囊探查中的安全性和有效性。
我们回顾性收集了 2018 年 5 月至 2022 年 6 月期间因睾丸扭转指征接受 SA 的 30 天以下新生儿的数据。我们记录了患者的人口统计学资料、辅助药物使用情况，以及脊髓注射开始/停止、手术和手术室使用的时间点。
六名新生儿，平均年龄为 1.9 天，平均体重为 3.4 公斤，因睾丸扭转接受 SA 进行阴囊探查。四名患者（67%）需要对扭转坏死的睾丸进行睾丸切除术，所有患者均对未受影响的睾丸进行了睾丸固定术。总手术时间平均为 45.3（SD 11.7）分钟，其中 5 名患者接受了 Gomco 环扎术。一名患者接受术前鼻内右美托咪定镇静。SA 给药的平均时间为 6.3（SD 5.5）分钟，手术室总时间平均为 77.3（SD 9.8）分钟。无围手术期或术后并发症。
我们描述了一家机构在 SA 下治疗新生儿扭转的手术管理经验。在这个病例系列中，SA 安全地用于所有涉及的新生儿，无需转为 GA 或静脉（IV）镇静。
SA 用于治疗新生儿睾丸扭转的紧急阴囊探查是安全有效的，即使是 48 小时以内的新生儿也是如此。更广泛的应用需要小儿泌尿科医生与接受过 SA 培训的有经验的小儿麻醉师之间的合作。
